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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 1, January/February 2020
4
AFRICA
first implantations were likely observerships) within 21 training
days over three years. Careful follow up and troubleshooting of
implanted pacemakers appear to be lacking or done remotely
from another country, which is not ideal. Implanters are also
likely to have an erosion of skills with the infrequent bursts of
pacing.
Our recent reports on cardiac arrhythmia services in Africa
incorporated most of the 14 countries mentioned in this article
and include a survey on training.
3,4
No operator reported training
through ‘Africa-Pace team’ missions. For instance, Dr Ikama,
featured in the article, was trained in France. Likewise, Niger is
included among 11 countries where cardiac pacing was initiated
through the mission. Yet, Niger is one of the 20% of African
countries without pacemaker activity.
3
Neither Niger (no existing
activity) nor Guinea Conakry (only one mission in 2014) should
have been included in this report.
The Pan-African Society of Cardiology (PASCAR) fellowship
started in 2016 and has trained pacemaker implanters from
three countries at Groote Schuur Hospital in Cape Town
through an intense six-month hands-on programme of device
implantation and follow up for doctors and technologists.
5
Subsequent on-site proctorship when the implanter returns to
his country is mandated.
A French-speaking pacing curriculum has been launched
in Dakar (Senegal) since 2017. Over 18 months, fellows must
perform 25 and 25 implantations as second- and first-hand
operator, respectively, with 100 device follow ups. The College of
Medicine of South Africa requires at least 30 and 10 single- and
dual-chamber pacemakers, respectively, as first implanter.
We therefore believe that episodic mission-based on-site
training is not a model to be recommended. This article
1
may
be misleading, as the situation on the ground does not reflect its
general message.
African populations need to be treated by well-trained
specialists. The message, aiming to maintain Africa outside
this standard of care, is devastating. Humanitarian missions
are welcomed in Africa but provide a mechanism to support
comprehensive training initiatives, which cannot replace
conventional curricula. Therefore, the misconceptions conveyed
by this article in the long term should be taken into account.
References
1.
Jouven X, Diop BI, Narayanan K, Adoubi A, Ba SA, Balde D,
et
al
; Africa-Pace Investigators from the African Research Network.
Cardiac pacing in Sub-Saharan Africa.
J Am Coll Cardiol
2019;
74
(21):
2652–2660.
2.
Zipes DP, Calkins H, Daubert JP, Ellenbogen KA, Field ME, Fisher
JD,
et al.
2015 ACC/AHA/HRS advanced training statement on clinical
cardiac electrophysiology (a revision of the ACC/AHA 2006 update of
the clinical competence statement on invasive electrophysiology studies,
catheter ablation, and cardioversion).
Heart Rhythm
2016;
13
(1): e3–e37.
3.
Bonny A, Ngantcha M, Jeilan M,
et al.
Statistics on the use of cardiac
electronic devices and interventional electrophysiological procedures
in Africa from 2011 to 2016: report of the Pan African Society of
Cardiology (PASCAR) Cardiac Arrhythmias and Pacing Task Forces,
EP Europace, eux353, 2017,
https://doi.org/10.1093/europace/eux353.4.
Talle MA, Bonny A, Scholtz W,
et al
. Status of cardiac arrhythmia
services in Africa in 2018: a PASCAR Sudden Cardiac Death Task Force
report.
Cardiovasc J Afr
2018;
29
: 115–121.
5.
Sani MU, Mayosi BM. The pacemaker and ICD reuse programme of
the Pan-African Society of Cardiology.
Heart
2017;
103
: 1844–1845.
District Hospital Bonassama, University of Douala, Cameroon
Aimé Bonny,
aimebonny@yahoo.frDouala Cardiovascular Research Network ‘homeland’
Aimé Bonny
Marcus Ngantcha
Cardiac Arrhythmia Center, David Geffen School of
Medicine, University of California, Los Angeles, USA
Olujimi A Ajijola
Aga Khan University Hospital, Nairobi, Kenya
Mohamed Jeilan
Loreen Akinyi
Bayero University/Aminu Kano Teaching Hospital, Kano,
Nigeria
Mahmoud Sani
Kamilu Karaye
University Hospital of Wales, Cardiff, Wales
Zaheer Yousef
VA Boston Healthcare System and Harvard Medical
School, Boston, USA
Matthew F Yuyun
Heart Beat for Medical Services, Cairo, Egypt
Mervat Aboulmaaty Nabib
Chu Mustapha Bacha, Alger, Algeria
Yazid Aoudia
Department of Cardiology, Khartoum Teaching Hospital,
Khartoum, Sudan
Saad Subahi
Georgia Arrhythmia Consultants & Research Institute,
Macon, Georgia, USA
Felix Sogade
Groote Schuur Hospital/University of Cape Town, South
Africa
Ashley Chin